Who gets treated at commission on cancer-approved programs and does it make a difference in survival?

Abstract

114 Background: Commission on Cancer (CoC) approval has promoted improvements in cancer care in the United States. The purpose of this study is to determine if there are differences in who is treated at CoC approved versus non-approved sites and if CoC approval is associated with survival. Methods: We examined 130,655 cases of stages I-IV first primary female invasive breast cancer from the California Cancer Registry diagnosed between 2000-2010. Odds ratios (95% CI) adjusted for stage, age, grade, year of diagnosis, and ER/PR/HER2 were computed to determine if there were differences by race: white, black, Hispanic, Asian/Pacific Islander (API) and American Indian (AI); SES (low, intermediate, high) or location (urban versus rural) in the likelihood of treatment at CoC sites. Cox regression was used to assess the risk of cancer specific mortality at CoC approved versus non-approved sites. Results: CoC-approved hospitals were more likely to be urban (89%) than rural (11.2%). Race and SES were associated with being treated at CoC sites. In the lowest SES group, blacks (OR=0.82; 95% CI=0.77, 0.89) and Hispanics (OR=0.90; 95%CI=0.86, 0.95) were less likely than whites to be treated at CoC sites. Similar ORs were seen in the intermediate SES group for blacks and Hispanics. In the highest SES stratum, blacks (OR=0.67; 95%CI=0.62, 0.74), Hispanics (OR=0.76; 95%CI=0.72,0.81), and APIs (OR=0.79; 95%CI=0.75,0.83) were less likely to be treated at CoC sites. Unadjusted survival was better for CoC sites (87% vs 85%). For Stage I, only whites treated at CoC approved sites had decreased risk of mortality (HR=0.86; 95%CI=0.79, 0.95). For Stage 2, whites (HR=0.87; 95%CI=0.82, 0.93) and APIs (HR=0.71; 95%CI=0.59, 0.86) had decreased risk of mortality. Blacks (HR=0.82; 95%CI=0.70,0.99) had slightly decreased risk of mortality. For stages III and IV, no difference in risk of mortality was apparent for any race at CoC-approved sites. Conclusions: Patients treated at CoC approved sites vary by race/ethnicity and SES. While the risk of mortality is reduced for some race/ethnicities in Stages 1 and 2 when treated at CoC-approved sites, for stages III and IV patients, CoC-approval does not make a difference in risk of mortality.